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. 2019 May 10;14(5):e0216112. doi: 10.1371/journal.pone.0216112

Table 7. Study characteristics, findings reported and the risk of bias assessments for studies that report on community outcomes (n = 20).

Study Country Study Design Sample Disease Category Type of
Community Involvement 		Type of Outcome Relevant Findings Risk of bias
s p d a r Overall
Ardalan et al
2010 [48] 		Iran RCT 15 intervention villages and 16 control villages Environmental Health Intervention assembles Village Disaster Taskforces (VDTs), conducts training of VDTs and community, evacuation drills, and program monitoring. Community Outcome 1) Adjusted odds ratio for participation in an evacuation drill in intervention area post vs. pre-assessment was 29.05 (CI: 21.77–38.76) compared to control area 2.69 (CI: 1.96–3.70) (p<0.001). 2) Participation in a family preparedness meeting and risk mapping were helpful in motivating individuals to take preparedness actions. Medium
Solomon et al 2014 [49] United Kingdom RCT (Stepped wedge cluster) 10,412 adults (intervention = 4693; control = 5719) Healthy Living Intervention developed with local partners using local knowledge and resources to facilitate local involvement in planning, promotion, and delivery of a physical activity intervention. Community Outcome Low penetration of intervention wherein 16% of intervention participants reported awareness of intervention and 4% reported participating in intervention events. High
Derose et al
2014 [50] 		United States RCT 33 intervention parks (2 interventions, 17 control parks Healthy Living CBPR approaches used to increase park use and physical activity across 33 neighborhoods. Community Outcome Intervention parks invested in new and diversified signage, promotional items, outreach or support for group activities like fitness classes and walking clubs, and various marketing strategies; working with departmental management established structures for community input and park policy facilitated implementation and sustainability. High
Caprara et al
2015 [17] 		Brazil RCT 10 intervention clusters, 10 control clusters Infectious Disease Intervention adopted an Ecohealth approach to involve community through workshops, clean up campaigns, mobilization of school children and seniors, and distribution of information, education, and communication materials. Community Outcome Increase in peoples’ knowledge of dengue and willingness to participate in preventive actions. Low
Study Country Study Design Sample Disease Category Type of
Community Involvement 		Type of Outcome Relevant Findings Risk of bias
s p d a r Overall
Sansiritaweesook et al 2015 [16] Thailand Intervention study 182 informants, 562 surveillance networks, 21,234 villagers Environmental Health 7-step process used to develop a model for local drowning surveillance system based on community participation. Community Outcome Additional drowning prevention and rescue devices made available at high risk water resources. Proportion of sites with devices increased from 18.4% to 83.7%. Sites with security measures increased from 13.2% to 76.7%. Level of surveillance at high risk sites rose from 88.4% to 100%. Children 7–15 years who could swim rose from 38.5% to 52% following swimming lessons. Training of rescue volunteers in CPR increased from 6% to 27.4%. Proportion of village health workers trained in CPR increased from 12.7% to 87.9%. Medium
Yajima et al
2001 [51] 		Japan Intervention study 20 participants each from 13 municipalities (intervention group), 2000 in reference group Healthy Living Health promotion program consisting of a community leaders committee trained to conduct health promotion activities. Community Outcome Intervention group pursued healthier lifestyles than the comparison group. 22% of the Intervention group and 4% of the comparison group frequently obtained information from health professionals. 29.8% of the intervention group and 10.8% of the comparison group were satisfied with their access to health-related information. Significantly more people in the Intervention group were doing exercise, eating meals regularly, paying attention to nutritional balance and to food additives, were interested in health, and were satisfied with access to health information after excluding the effects of age and socio-economic factors (p<0.05). People in the intervention group were significantly more likely to have greater health literacy regardless of socio-economic status. Unclear
Neto et al 2003 [21] Brazil Intervention Study 1,524 households in intervention area; 1,564 households in control area Infectious Disease A preliminary diagnosis presented to the community to launch a discussion aimed at defining future actions, implementation of the actions in the study area with community participation. Community Outcome Potential domiciliary breeding sites were significantly reduced; the proportion of houses without breeding sites was significantly increased; and there was an increase in the percentage of individuals who recognized the larval form of the vector in the study area as compared to the control area. Unclear
Clark et al
2014 [22] 		United States Intervention study 1,477 parents of children with asthma in coalition target areas and comparison areas Non Communicable Disease Allies Against Asthma program—a 5-year collaborative effort by 7 community coalitions designed to change policies regarding asthma management in low-income communities of color. Community Outcome Allies parents, significantly more so than the comparison group parents, felt less helpless or frightened when confronted by a symptom episode (mean score change: 0.30 vs. 0.75; p = 0.014) and less angry about their child’s asthma (mean score change: 0.16 vs. 0.57; p = 0.011). Allies parents exhibited a greater increase in concern than did comparison parents about medications and side effects (mean score change: 1.22 vs. 0.79; p = 0.022), indicating higher awareness. Unclear
Study Country Study Design Sample Disease Category Type of
Community Involvement 		Type of Outcome Relevant Findings Risk of bias
s d n c Overall
Davison et al
2013 [46] 		United States Cohort 423 children age 2–5 Healthy Living CBPR used to develop and pilot test a family-centered intervention for low-income families with preschool-aged children. Community Outcome Parents at post intervention reported significantly greater self-efficacy to promote healthy eating in children and increased support for children’s physical activity. Dose effects observed for most outcomes. Low
Study Country Study Design Sample Disease Category Type of
Community Involvement 		Type of Outcome Relevant Findings Risk of bias
1 2 3 4 5 6 7 8 9 Overall
Ferrera et al
2014 [15] 		United States Qualitative 23 youths interviewed Community Health CBPR used to form Youth advisory board and youth involved in decision making and programming, as well as in a feedback and improvement role. Community Outcome Greater knowledge of health issues and the importance of screening. Y Y Y Y Y N N N N Y Medium (6/10)
Heaton et al
2014 [32] 		United States Qualitative Interviews, focus groups Community Health Collaborative partnership between 2 academic health centers and CBOs to determine topics, and develop a bi-directional educational seminar series called 'Community Grand Rounds'. Community Outcome Increased knowledge and awareness on health and social issues among community; Improved trust between academic partners, and community. N Y Y Y Y Y Y Y N Y Low (8/10)
Litt et al
2013 [33] 		United States Qualitative 59 participants from collaboratives interviewed Healthy Living Multi-sectoral collaborative groups promote active lifestyles through environmental and policy changes Community Outcomes Most groups achieved some form of environmental or policy change. N Y N N N N N N N N High (1/10)
Campbell et al 2001 [52] South Africa Qualitative 30 members of community interviewed Infectious Diseases A community-based peer education program led by sex workers as an initiative in grassroots participation in sexual health promotion. Community Outcomes Increased confidence and personal development among peer educators and increased confidence among some sex workers. Y Y Y Y N N Y N Y Y Medium (7/10)
Chervin et al
2005 [35] 		United States Qualitative 364 in-person interviews with project staff, evaluators, and community and agency members Infectious Diseases Centers for Disease Control and Prevention’s Community Coalition Partnership Program (CCPP)—building a community’s capacity to prevent teen pregnancy through strengthening of partnerships, mobilization of community resources, and changes in the number and quality of community programs. Community Outcome 1. Increased community awareness of the problem of teen pregnancy and willingness to discuss the issue; 2. Improved knowledge and skills relating to addressing teen pregnancy. N Y Y Y Y Y Y N N N Medium (6/10)
Study Country Study Design Sample Disease Category Type of
Community Involvement 		Type of Outcome Relevant Findings Risk of Bias
Orozco-Núñez et al 2009 [39] Mexico Case Study Not mentioned Community Health Use of participative strategies and the creation of support networks for poor pregnant women. Community Outcome Governmental actors’ involvement and leadership favored linking and coordination. Authorities, relatives, volunteers and users supported the referrals for obstetric emergencies, the identification of pregnant women in isolated areas, and their referral to health services. Around one-third of the users indicated geographical, economic, and cultural access barriers to health services in the four states, particularly those living in rural areas. Even though most of the informants received timely attention with a favorable evaluation of the treatment received in the units, testimonies were collected from users reporting feeling abused by transporters and suppliers. N/A
Setti et al 2010 [53] Brazil Case Study 24 participants Environmental Health The Neighborhood Ecological Program that involved the participation and empowerment of citizens in health promotion and sustainable development Community Outcome The program is reported to promote empowerment and community strengthening, dissemination of information and knowledge, development of critical thinking, and the creation of support networks. N/A
Barnes et al
2006 [43] 		United Kingdom Case Study Not mentioned Non Communicable Diseases Users of a community mental health inter-professional training program (partnerships with service users) involved in the commissioning, management, delivery, participation, and evaluation of the program, as trainers and as course members. Community Outcome 1) Increase in mean of 'knowledge of factors involved in facilitating therapeutic cooperation' [5.8 (2.2 SD) vs. 8.3 (1.2 SD), p<0.001]. 2) Increase in mean of 'skills in facilitating therapeutic cooperation' [5.9 (2.3 SD) vs. 8.2 (1.3 SD), p<0.001]. 3) Increased in mean of 'A user-and carer- oriented perspective based on partnership in the provision of assessment, treatment and continuing care' [6.0 (2.1 SD vs. 8.5 (1.2 SD), p<0.001)]. 4) Increased knowledge on learning where and how to access information, developing directories of local service user groups/resources, and understanding the value of advocacy. 5) Positive changes in attitudes towards partnership with service users. 6) Positive changes in behavior at individual level, e.g. students more conscious of sharing decision-making and using a needs-led approach following awareness of the imbalance of power between service users and professionals. 7) Positive changes in behavior at organizational level, e.g. the setting up of service user groups, ensuring user views are fed into planning decisions, supporting service users on staff recruitment panels, writing leaflets for users/carers about services offered, and collating info on resources for users. N/A
Wilson et al
2014 [54] 		United States Case Study 71 participants Infectious Diseases CBPR used to develop the Barbershop Talk With Brothers (BTWB) program—a community-based HIV prevention program that seeks to improve individual skills and motivation to decrease sexual risk, and that builds men’s interest in and capacity for improving their community’s health. Community Outcome 1) Proportion of men who reported not having engaged in unprotected sex in past 3 months increased from baseline to follow-up administration of survey (25% to 41%, p = 0.007). 2) Proportion of men who reported having unprotected sex with two or more women in the past 3 months declined (46% to 17%, p = 0.0001). 3) Proportion of men reporting favorable attitudes towards condoms and confidence in their self-efficacy to use condoms consistently increased (p<0.05). 4) HIV stigma decreased, but difference did not reach statistical significance (Mean = 24.7; SD = 8.4 to Mean = 22.8; SD = 8.8; p = 0.11). N/A
Diaz et al 2009 [42] Cuba Case Study Not mentioned Infectious Diseases Ecohealth approach used as a strategy to ensure active participation by the community, diverse sectors, and government. The approach allowed holistic problem analysis, priority setting, and administration of solutions. Community Outcome At the outset, 85% of the outbreaks of the dengue vector were in tanks located in the patios of the houses. Two years later only 29% were located in the patios. Currently, no outbreaks have been identified in the deposits located in the houses. It was found that 16% of the 4,878 courtyards in the territory were unhealthy. Two years after the end of the study, these constituted less than 1%; The number of unprotected tanks decreased from 62% to 8% (n = 4,678). N/A
King et al
2011 [55] 		American Samoa Case Study 50 representatives from churches interviewed Infectious Disease Modified the initial Mass Drug Administration (MDA) strategy and partnered with various community groups including church groups for drug distribution, dissemination of messages about prevention of filariasis, and to encourage compliance. Developed radio and television ads to encourage "pill taking" and advertising locations of distribution. Community Outcome 261 detailed surveys– 95.4% had heard of filariasis and increase (x2 = 19.2; p<0.001) from the 2003 KAP survey. Among those heard of filariasis 91.2% knew what it was an increase (x2 = 20.1; p<0.001) from 2003. N/A